scholarly journals Lyme carditis presenting as atrial fibrillation

2019 ◽  
Vol 12 (4) ◽  
pp. e228975 ◽  
Author(s):  
Abir Zainal ◽  
Amir Hanafi ◽  
Ninad Nadkarni ◽  
Mahmood Mubasher ◽  
Deeraj Lingutla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Heart Block ◽  
Cardiac Involvement ◽  
Lyme Carditis ◽  
Rare Manifestation ◽  
The Usa ◽  
Ventricular Response ◽  
Degree Heart Block

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

scholarly journals Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Maxwell Eyram Afari ◽  
Fady Marmoush ◽  
Mobeen Ur Rehman ◽  
Umama Gorsi ◽  
Joseph F. Yammine
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Complete Heart Block ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Young Female ◽  
Cardiac Conduction ◽  
Lyme Carditis ◽  
Uncommon Presentation ◽  
Degree Heart Block

Carditis is an uncommon presentation of the early disseminated phase of Lyme disease. We present the case of a young female who presented with erythema migrans and was found to have first-degree heart block which progressed to complete heart block within hours. After receiving ceftriaxone, there was complete resolution of the heart block in sequential fashion. Our case illustrates the importance of early recognition and anticipation of progressive cardiac conduction abnormalities in patients presenting with Lyme disease.

scholarly journals A 34-Year-Old Woman with Third-Degree Heart Block and Atrial Flutter Associated with Lyme Carditis: A Case Report

2021 ◽  
Vol 22 ◽  
Author(s):  
Vishal Khetpal ◽  
Tyler W. Wark ◽  
Rebecca Masel ◽  
Cao Thach Tran ◽  
Philip Haines
Keyword(s):  
Case Report ◽  
Atrial Flutter ◽  
Heart Block ◽  
Lyme Carditis ◽  
Degree Heart Block

scholarly journals Lyme carditis presenting as atrial fibrillation in a healthy young male

2019 ◽  
Vol 12 (6) ◽  
pp. e229261 ◽  
Author(s):  
Muhammad Asim Shabbir ◽  
Muhammad Hamza Saad Shaukat ◽  
Muhammad Hashaam Arshad ◽  
Joseph Sacco
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Young Male ◽  
Rare Presentation ◽  
Normal Sinus ◽  
Lyme Carditis ◽  
Appropriate Treatment ◽  
High Degree

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy—reverted to normal sinus rhythm and discharged home. He returned a few days later—this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.

scholarly journals First case report of inducible heart block in Lyme disease and an update of Lyme carditis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Don Walter Kannangara ◽  
Sindhu Sidra ◽  
Patel Pritiben
Keyword(s):  
Case Report ◽  
Lyme Disease ◽  
Heart Block ◽  
Lyme Carditis ◽  
First Case

scholarly journals Lyme Carditis in Hospitalized Children and Adults, a Case Series

2021 ◽  
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Case Series ◽  
Outpatient Setting ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme carditis is an uncommon manifestation of Lyme disease. This report compares Lyme carditis presentation, management, and outcomes in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block (PR >300ms) and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children and 20 adults were admitted for Lyme carditis between June and October. Ninety percent were male, and 87% had no prior cardiac history. Seventeen had outpatient evaluation prior to admission. Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment. The most common alternate diagnoses were viral illness and erythema multiforme. More children than adults had disseminated erythema migrans and fever. First-degree heart block was more prevalent in children, and Mobitz type 2 heart block was more prevalent in adults. Ten patients presented with syncope. Proportionately more adults needed temporary pacing. Children had shorter antibiotic durations compared to adults. Of the 30 cases, twenty-seven had improved heart block, while 3 adults required a pacemaker at discharge. Nine children and 14 adults were discharged with a PR 200-300ms. There was a single death in this series. Conclusion Cases tended to be younger males. Most patients had some heart block on discharge. Of patients evaluated as outpatients, Lyme disease was suspected in 41%. Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.

scholarly journals Lyme Carditis Presenting as Sinus Node Dysfunction and Accelerated Junctional Rhythm

2020 ◽  
Vol 3 (12) ◽  
pp. 01-03
Author(s):  
Saima Karim ◽  
Roy Arjoon ◽  
B. Julie He ◽  
Lynda Rosenfeld ◽  
Paras Bhatt
Keyword(s):  
Lyme Disease ◽  
Cardiac Involvement ◽  
Sinus Node ◽  
Sinus Node Dysfunction ◽  
High Index ◽  
Av Block ◽  
Junctional Rhythm ◽  
Lyme Carditis ◽  
Uncommon Presentation ◽  
High Index Of Suspicion

Lyme disease can have cardiac involvement and can subsequently present with various types of atrio ventricular (AV) block. Sinus node dysfunction (SND) and accelerated junctional rhythm are highlighted in this case as an uncommon presentation for Lyme Carditis. This case highlights the importance of having a high index of suspicion for cardiac involvement with Lyme disease when atypical arrhythmias are present.

scholarly journals 134. A Comparison of Lyme Carditis in Children and Adults, a Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S95-S95
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Erythema Migrans ◽  
Case Series ◽  
Adult Patients ◽  
Male Predominance ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme disease is a common entity in Maine, and Lyme carditis is an uncommon manifestation of this disease. This case series describes and compares the presentation, management, and outcomes of Lyme carditis in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children (range 7–17, mean 12.4 years) and 20 adults (range 22–81, mean 41.4 years) were admitted for Lyme carditis in the examined period. All cases presented between June and October. Twenty-seven (90%) were male, and 26 (87%) had no prior cardiac history. Of the adults, 1 (5%) reported using cocaine, 4 (20%) opioids, and 6 (30%) marijuana. Seventeen (57%) had outpatient evaluation prior to admission. Ten patients (59%) were not recognized as having Lyme disease. One case suspected to have Lyme was not initially treated with doxycycline. The most common alternative diagnoses were a viral illness and erythema multiforme. No coinfections were noted. Proportionately more children than adults had disseminated erythema migrans (40% vs. 20%) and fever (60% vs. 35%). First degree heart block was more prevalent in children (40%), and Mobitz type 2 heart block was more prevalent in adults (55%). Ten patients (30%) presented with syncope. More adults than children needed temporary pacing, 9 (45%) vs. 2 (20%). Children had shorter antibiotic durations compared with adults (mean 19.8 days vs. 23.6 days) Twenty-seven (90%) had improved heart block. Three adult patients (10%) required a pacemaker following hospitalization. Nine (90%) children and 14 (70%) adults were discharged with a PR 200-300ms. There was a single death in this series, which occurred after discharge to another state. Conclusion Cases tended to be in younger patients with male predominance. Most patients still had some degree of heart block on discharge. The majority of patients were evaluated prior to hospitalization but Lyme disease was suspected in only 41%. Improved recognition of early Lyme disease and more prompt treatment may lead to decreased complications of Lyme carditis. Disclosures All authors: No reported disclosures.

scholarly journals Safety and Efficacy of Dronedarone in the Treatment of Atrial Fibrillation/Flutter

2011 ◽  
Vol 5 ◽  
pp. CMC.S6677 ◽  
Author(s):  
Gerald V. Naccarelli ◽  
Deborah L. Wolbrette ◽  
Vadim Levin ◽  
Soraya Samii ◽  
Javier E. Banchs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Rate Control ◽  
Decompensated Heart Failure ◽  
Term Treatment ◽  
Long Term Treatment ◽  
The Usa ◽  
Ventricular Response

Dronedarone is an amiodarone analog but differs structurally from amiodarone in that the iodine moiety was removed and a methane-sulfonyl group was added. These modifications reduced thyroid and other end-organ adverse effects and makes dronedarone less lipophilic, shortening its half-life. Dronedarone has been shown to prevent atrial fibrillation/flutter (AF/AFl) recurrences in several multi-center trials. In addition to its rhythm control properties, dronedarone has rate control properties and slows the ventricular response during AF. Dronedarone is approved in Europe for rhythm and rate control indications. In patients with decompensated heart failure, dronedarone treatment increased mortality and cardiovascular hospitalizations. However, when dronedarone was used in elderly high risk AF/AFl patients excluding such high risk heart failure, cardiovascular hospitalizations were significantly reduced and the drug was approved in the USA for this indication in 2009 by the Food and Drug Administration. Updated guidelines suggest dronedarone as a front-line antiarrhythmic in many patients with AF/Fl but caution that the drug should not be used in patients with advanced heart failure. In addition, the recent results of the PALLAS trial suggest that dronedarone should not be used in the long-term treatment of patients with permanent AF.

scholarly journals Chest palpitations in a teenager as an unusual presentation of Lyme disease: case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Faith Myers ◽  
Pooja E. Mishra ◽  
Daniel Cortez ◽  
Mark R. Schleiss
Keyword(s):  
Chest Pain ◽  
Lyme Disease ◽  
Antibiotic Therapy ◽  
Heart Block ◽  
Left Ventricular ◽  
Uneventful Recovery ◽  
Lyme Carditis ◽  
Cardiac Symptoms ◽  
Disease Case ◽  
Pr Interval

Abstract Background The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children’s hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population. Case presentation The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery. Conclusions Lyme carditis occurs in < 5% of LD cases, but the “take-away” lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.

Presentation and Management of Cardiac arrhythmias ... an analysis of 75 referrals from Family Medicine Practitioners

2009 ◽  
Vol 5 (1) ◽  
pp. 17-19
Author(s):  
Manzoor Mahmood ◽  
SA Mahmood ◽  
Md Zahid Hossain ◽  
MA Quayum ◽  
A Qader ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Family Medicine ◽  
Cardiac Arrhythmias ◽  
Heart Block ◽  
Ventricular Arrhythmias ◽  
Sinus Bradycardia ◽  
Clinical Manifestations ◽  
Family Physicians ◽  
Cardiology Clinic ◽  
Degree Heart Block

Cardiac arrhythmias often present to family physicians with diverse clinical manifestations. This retrospective observational study was carried out in a private cardiology clinic in Dhaka from July 2004 to December 2008. A total of 1257 patients were referred from family physicians in the locality. 75 (5.96%) patients were diagnosed as having cardiac arrhythmia by ECG. Various types of atrial arrhythmias are more common than ventricular arrhythmias (60% vs 40%). Atrial fibrillation (N=18) and PVC (N=17) are the 2 commonest arrhythmias found in this study. This study identifies the clinical presentation, possible aetiology and management of patients having cardiac arrhythmias. Palpitation (46.66%) and asymptomatic ECG changes (34.66%) were the 2 most common reasons for referral. Most of the patients could be managed on a out-patient basis. Most arrhythmias like 1st degree heart block, PAC & isolated PVC, RBBB, Sinus bradycardia were asymptomatic & did not need any further treatment except assurance & anxiolytics. Other arrhythmias like atrial fibrillation, LBBB, bifascicular or advanced heart block, SSS & SVT needed further evaluation. This article particularly focuses on the general approach of family physicians while dealing with patients with cardiac arrhythmias. Key words: cardiac arrhythmias, family medicine practice   doi: 10.3329/uhj.v5i1.3435 University Heart Journal Vol. 5, No. 1, January 2009 17-19

Sign in / Sign up

Export Citation Format

Share Document